• Jeffrey G Jarvik, Laura S Gold, Bryan A Comstock, Patrick J Heagerty, Sean D Rundell, Judith A Turner, Andrew L Avins, Zoya Bauer, Brian W Bresnahan, Janna L Friedly, Kathryn James, Larry Kessler, Srdjan S Nedeljkovic, David R Nerenz, Xu Shi, Sean D Sullivan, Leighton Chan, Jason M Schwalb, and Richard A Deyo.
• Department of Radiology, University of Washington, Seattle2Department of Neurological Surgery, University of Washington, Seattle3Department of Health Services, University of Washington, Seattle4Comparative Effectiveness, Cost and Outcomes Research Center.
• JAMA. 2015 Mar 17;313(11):1143-53.

ImportanceIn contrast to the recommendations for younger adults, many guidelines allow for older adults with back pain to undergo imaging without waiting 4 to 6 weeks. However, early imaging may precipitate interventions that do not improve outcomes.ObjectiveTo compare function and pain at the 12-month follow-up visit among older adults who received early imaging with those who did not receive early imaging after a new primary care visit for back pain without radiculopathy.Design, Setting, And ParticipantsProspective cohort of 5239 patients 65 years or older with a new primary care visit for back pain (2011-2013) in 3 US health care systems. We matched controls 1:1 using propensity score matching of demographic and clinical characteristics, including diagnosis, pain severity, pain duration, functional status, and prior resource use.ExposuresDiagnostic imaging (plain films, computed tomography [CT], magnetic resonance imaging [MRI]) of the lumbar or thoracic spine within 6 weeks of the index visit.Main Outcome And MeasuresPrimary Outcomeback or leg pain-related disability measured by the modified Roland-Morris Disability Questionnaire (score range, 0-24; higher scores indicate greater disability) 12 months after enrollment.ResultsAmong the 5239 patients, 1174 had early radiographs and 349 had early MRI/CT. At 12 months, neither the early radiograph group nor the early MRI/CT group differed significantly from controls on the disability questionnaire. The mean score for patients who underwent early radiography was 8.54 vs 8.74 among the control group (difference, -0.10 [95% CI, -0.71 to 0.50]; mixed model, P = .36). The mean score for the early MRI/CT group was 9.81 vs 10.50 for the control group (difference,-0.51 [-1.62 to 0.60]; mixed model, P = .18).Conclusions And RelevanceAmong older adults with a new primary care visit for back pain, early imaging was not associated with better 1-year outcomes. The value of early diagnostic imaging in older adults for back pain without radiculopathy is uncertain.

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